A stack of toilet paper on a wooden table.

17 Jun

2024

Tackling toilet training with autistic children

Toilet training is a major life skill that takes considerable time and effort to master. Many autistic children face more challenges than neurotypical children when it comes to toilet training, making it harder to start and progress with this skill. But with the right information and a supportive environment, families can successfully help their autistic child with toilet training.

In this post, we’ll discuss how parents and carers can approach the different stages of toilet training for their autistic child. We’ll also share what families can do if challenges arise and where they can receive additional support.

Before you start
Different approaches
Common challenges and solutions
Your next steps

Before you start

Before you start toilet training, there are a few skills your child will need to demonstrate:

Some awareness of urinating
Periods of time when their nappy is dry
An ability to sit comfortably for at least ten minutes
Understanding of ‘first, then’ instructions (verbal, written or visual)

You can observe when your child’s nappy is typically dry during the day and how long it remains dry. This can be very useful for knowing how frequently your child can try using the toilet each day and increases your chance of success.

There are a few other questions parents, carers and others involved in the toilet training process might ask before beginning toilet training:

Is the child safe?

Think about any safety concerns that might come up when toilet training your autistic child. If they have self-injurious behaviours, it’s important to address them first, ideally with a professional who can work directly with your child and family.

Additionally, your child must be free of any medical issues before beginning toilet training. Health problems like chronic constipation or diarrhea must be treated medically before toilet training begins.

Is your child happy?

Is your child comfortable in and around bathrooms? Do they have any anxieties, fears, or phobias about bathrooms or toilets? These behaviours can make toilet training extremely difficult, and addressing these before starting will make the process much easier and safer for everyone involved.

Is your child motivated?

Does your child show any motivation to start toilet training? Can you help create a desire for them to start or make progress? A motivating environment can really boost your child’s success. Some families use rewards and incentives to help with motivation, while others might not - this is entirely up to you.

Misconceptions around toilet training

There are many misconceptions about autism and toilet training that can create challenges for autism families, sometimes discouraging them from trying at all. Understanding these misconceptions before you start is important so they do not delay or complicate things for you and your child.

Dressing skills: your child doesn’t need to be able to take their pants, underwear or pull-up nappy on or off independently to start toilet training. Dressing and toileting skills can be learnt and practised simultaneously.
Imitation skills: Being able to copy or imitate actions isn’t a must. Key toileting skills can be taught and communicated in different ways.
Language skills: communicating verbally or understanding verbal instructions is not necessary for toileting. Using alternative communication methods can be just as effective as long as they are clear to the child.

Just like learning any skill, teaching toilet training to a child with autism will look different from teaching a neurotypical child. Remember, as long as your child is safe, happy and comfortable, there’s no ‘right’ or ‘wrong’ way or timeframe to teach this important skill.

Getting started

Once you feel confident that you and your child are ready to start toilet training, it’s time to plan how you will teach and support them. Having a clear plan can make the process much less confusing and overwhelming for everybody involved.

To get started, families must outline how much time they can realistically dedicate to toilet training their autistic child. Some toilet training methods are more intensive and involve scheduling times in the day, while others are less structured. The time commitment will also depend on who is involved in the process, whether that’s one parent, two parents, carers, relatives, or professionals.

Once families have agreed to the time commitment and mental effort needed for toilet training, it’s time to get ready with the following:

Seat/potty/insert that your child can sit on safely and comfortably for several minutes. Keeping the bathroom or toilet area warm and comfortable can boost their motivation and your chance of success (starting toilet training in the warmer months can be helpful for this reason).
Toys, objects or activities your child can hold, fidget and play with to reduce anxiety or boredom while they wait.
Keep changes of clothes or nappies close by. In warmer months, it might be easier to keep your child in just a nappy or underwear at home, as there are less layers of clothing to change in and out of.
Fluids the child can drink regularly. This gives your child more chances to practise going to the toilet and ensures they remain hydrated throughout the day.

Some families use rewards, like toys or snacks, to motivate their child during toilet training. Having these ready before you start and keeping them in or near the bathroom makes them easily accessible for you and helps your child to associate using the toilet successfully with objects or activities that are fun and exciting.

Practice sessions

Once families know how to approach toilet training and what they need to get started, having some practice sessions can help build your child’s understanding and confidence. Here are some helpful tips to make these sessions successful:

Showing books or videos around toilet training, especially if your child responds well to visual instructions. Tailoring these to their special interests, like princesses or dinosaurs, is a great way to engage your child.
Practise spending ten to fifteen consecutive minutes in the bathroom, even if they do not use the toilet or potty. This allows a child to become used to spending time in the bathroom and more comfortable in this space. This is a great time to introduce any toys or activities you’ll use during toilet training to boost motivation.
Sitting on the toilet or potty for five minutes, gradually working up to ten and fifteen minutes.
Giving ‘First, then’ instructions (e.g., ‘first, we go to the toilet, then we wash our hands, then we play outside).
Spending time without wearing a nappy. For children who might need a more gradual transition out of nappies, cutting a hole in the nappy or wearing underwear inside of the nappy can be helpful.

Different approaches

There are many different ways to tackle toilet training, which can be confusing and overwhelming for parents and carers who are new to the process. This is especially true for parents and carers of autistic children, whose learning style and pace will be very different from those of a neurotypical child.

It’s common for family members, friends and others to offer advice during this time, and while they might mean well, their suggestions may not be the best approach for a child on the autism spectrum. Remember, you’re not obliged to follow everyone’s advice. Take the tips you believe will work best for your family and kindly ignore the rest. You know your child best.

Two main approaches to toilet training are ‘schedule training’ and ‘initiation training.’ Schedule training involves trying to use the toilet at certain times each day, usually when you think your child will need to use the toilet. Initiation training, on the other hand, is more intensive and involves using the toilet more frequently at unscheduled times. Professionals recommend that families start with scheduled training since it is less demanding on the child. Based on your child’s progress, you can then decide to move to initiation training or remain with scheduled training.

Below are some decisions families should make around their approach to toilet training:

How many people will be involved? One parent, two parents, relatives, educators?
How many locations will you use? Will you practise toileting at home, or will you extend this to other environments such as relative’s houses or childcare?
Will the child or the parents/carers lead the process?
Will you use rewards when toilet training?

If multiple people are helping to toilet train the same child, it is important to have clear and open discussions about how the process will work. If everyone teaches the process differently, especially when rewards are involved, your child will likely become confused or upset, which can slow their progress. When everyone uses the same approach, your child will feel much more supported and encouraged.

Common challenges and solutions

Inevitably, some challenges will arise when toilet training your child. By closely observing your child’s mood and behaviour, you can identify and address these challenges sooner rather than later, helping everyone stay on track and preventing any health or emotional challenges from developing.

In the early stages of toilet training, there can be a lot of trial and error when teaching your child how actually to use the toilet and achieve that first success. Your child might find books and pictures helpful or prefer to watch videos. Discovering how they learn best is an important first step in addressing any challenges or regression.

Consider other aspects of the environment or process that might not be working for your child. For example, if a child is struggling with scheduled training, try adjusting the times of day they use the toilet. If phasing out of nappies is challenging, using a combination of underwear and nappies might help the child feel more comfortable.

Many parents and carers have concerns about their child using the toilet for urination but struggling with bowel movements or having accidents at night. It’s normal for this to occur much later, especially with night-time training, which usually starts once a child has consecutively dry nappies at night for a whole month.

Some children may avoid using the toilet during toilet training, which can cause health problems like urinary tract infections (UTIs) if not addressed. If your child shows this behaviour or other behaviours of concern, seek professional advice right away to make sure they have no underlying health issues affecting their toileting

If you are still struggling to address the challenges you’re experiencing with toilet training, it might be best to seek professional support. Psychologists, occupational therapists, and behaviour support therapists can all be very helpful to families.

Your next steps

Toilet training is a big milestone for any family, particularly when a child is on the autism spectrum. Remember to be kind and patient to yourself and your child as you navigate this process.

For more information about toilet training autistic children and seeking further support, you can visit the links below: